Is ADHD in adults a big old con?

0:02 A listener production. Well, welcome to another solo episode of Crappy to Happy. I am Cass and I am your host. I have just returned from my trip to Amsterdam just to give you a little personal update, where I've been invited to work with a company up there on their corporate wellbeing plan for twenty twenty three. So that is super fun, really worthwhile work. Love getting into organizations and working with fabulous, creative, talented people and helping them live healthier, happier lives by all meets. Give me a shout if you want me to come and work with your organization.

0:43 But meanwhile, let's get into the topic for today. And this is something that I wasn't planning to talk about. I was just inspired to talk about this today following recent BBC Panorama expose on the over diagnosed of ADHD in private clinics here in the UK and what an uproar that has created on the internet. I'm not an ADHD expert, but I was really I had some things to say about this whole situation which I thought I would share with you. As you probably know, I have talked about ADHD here on the show. I've talked about it in relation to procrastination. I've had Canden Phillips, who is an ADHD expert and coach on the show to discuss ADHD and how it presents and why it is being so frequently diagnosed now and what hasn't been in the past. This kind of gotcha journalism, this undercover reporting where a BBC journalist went into private ADHD clinics and got an ADHD diagnosis in a relatively short space of time when he in fact doesn't have ADHD, has really potentially caused a lot of people to question and even more how real some of these diagnoses are. And there are plenty of people who really are skeptical about ADHD and the rate at which it's being diagnosed, particularly in

2:14 adults at the moment, and certainly a show like this, a presentation like this doesn't help. In contrast to those private in contrast to the experience of his rapid diagnosis in those online clinics, he had an assessment with an NHS which is public health provider here in the UK, with an NHS psychiatrist which was much more in depth, much longer, in which it was found that he does not have ADHD, and so he used that as the kind of gold standard, this is what should happen in an ADHD assessment, compared to what then happened when he fronted up and paid a lot of money to some private clinics, private assessors here in the UK, and obviously there are private practicing psychiatrists and psychologists in most countries, so that's no different. And use this to sort of say that this is a scandal and that a whole lot of people who don't have ADHD are being pandered a diagnosis and then prescribed this strong stimulant medication when they potentially do not have the diagnosis, and how dangerous that can be. And no question, if somebody's being diagnosed stimulus medication and they don't have the diagnosis, then that shouldn't be happening. But let's talk about what was really happening here. Let's just unpack this a little bit from my perspective as a psychologist, and again I'm not an ADHD expert, but I do have some understanding of how these conditions are diagnosed and assessed and how they're potentially treated. So,

3:45 first of all, just in terms of the journalistic quality of this program, it started with a tip off from a patient or a parent of a patient who was concerned that her daughter had been diagnosed very quickly and she was concerned with the diagnos wasn't accurate. These private clinics also charge a lot of money, by the way, so there's that there's this whole idea that this is a money grabbing thing. So it started off. He went to an NHS psychiatrist who knew that this was being filmed for a BBC Panorama episode. The psychiatrists in the NHS had plenty of time to prepare and he spent three to three and a half hours with this journalist to provide a full and complete assessment before telling him that he does not have ad EHD. The rationale for presenting this was that he wanted to show what a proper diagnostic process should look like, like how it's supposed to happen, and then compare it to what did happen.

4:43 I'm going to say upfront, I love the NHS. I live in the UK and I think they're great. They're chronically underfunded. The Tory government has been just gutting them for the last twelve years. They are under resourced. You wait forever for an appointment. You know, you don't pay for it once you get there, but you do wait forever for an appointment, and reportedly the wait for an ADHD diagnosis with the NHS at the moment is five years. You cannot tell me that any NHS psychiatrist has got the time to spend three and a half hours doing a full and thorough assessment for ADHD unless they know they're being filmed by the BBC. So any of us in our jobs, if we know we're being filmed and we know we are presenting best practice, of course we are going to be doing our utmost to make sure that we present the absolute gold standard in terms of service.

5:37 We'd be fools not to I don't think, and I know people in the UK and other NHS and private practicing clinicians in this country have all agreed that that's unlikely to happen in real life. Appointments don't typically go for three and a half hours. Don't hold me to that. I don't know. I'm just speculating that. I don't think that would really happen if he was a patient who walked off the street after a five year weight and if you've got a line of five years worth of weight out the door. Nobody spending that much time conducting an assessment. The other thing about psychological conditions in general is that they rely on patient report. If somebody comes to me as a psychologist and presents as depressed or anxious, or they describe to me the symptoms they're experiencing, the only thing I have to go on is what they tell me. We have assessments, we have checklists. They're all checklists.

6:35 There was a big who are in this article about how this was a tick box checklist type of a process. I mean, yes, we probe and we draw out more information, but we're all using checklists, and we are relying on patients to tell us what they're experiencing. There's not a blood test for depression, there's no brain scan at this point for EDDIEHD, there's no care what does all swab for anxiety? We take patients at their word. We ask them to describe for us what they're experiencing. And so that is the thing that sets psychological conditions apart from other medical conditions. It's why it's also so effective that they can be conducted online, because there's no physical examination for a mental health condition. You know, this idea that these assessments are being conducted quickly online and that they're just going off what the patient told them and handing out an assessment. Well, you know, it's probably not unusual.

7:36 That's what we have to go on. If somebody has walked into a clinic and described all of the symptoms of ADHD, and they've showed up at an appointment and paid a lot of money because presumably they believe this is what's going on for them, then there's no wonder that they're getting a diagnosis because they're describing the condition. So I think that that's a really important point to make. To get a diagnosis, you have to describe a condition. Now, some people will say, well, yes, this is the reason why with ADHD we talk to the other people around that person, and in ideal circumstances, then yeah, that is what should happen. I did talk to Canton about this, and there's various reasons why that's not necessarily helpful. And as an adult too, you know, you don't always have access to the people who are around during your childhood.

8:30 If you're providing a developmental history and you're recalling how things were for you at school or growing up, you only have your own memory. A lot of people have very foggy memories and that's sometimes part of the condition. Sometimes people don't remember a lot of what was going on in childhood. Of course, the ideal is to have other people, you know, collaborate your self report with other people's reports. It's not always possible. So there's that. I just wanted to make that point. The other thing is that as a psychologist, I will spend time with the person and they can tell me what they're experiencing, and I know the DSM. I've been clinically trained, and I can pretty much diagnose depression or anxiety or have an idea that maybe this looks a little bit like bipolar, or maybe this looks a little bit like, you know, some other mental health condition. As a psychologist in Australia, I don't make a diagnosis, and I think that's kind of across the board, unless perhaps it's different in the States where psychologists do a high level of study, and you know often in the UK as well, they all have a PhD. You can't be a clinical psychologist in other countries besides Australia unless you have a doctorate, So it may be different, but certainly in Australia, I can make a provisional diagnosis if for any reason a patient

10:02 of mine needs, for example, a more comprehensive assessment, or if they need to have their medication adjusted. If the GP has put them on some medication and it's not really working, or that needs to be tweaked and it needs more higher level kind of assessment of what's going on medication wise, then that will be referred to a psychiatrist. When somebody goes to a psychiatrist, when that psychiatrist sees the person, they are taking all of the information that I've already gathered. And remember that before a person comes to see me, often they've also already been to a GP. So a GP has conducted an initial screening, They've decided that this person should see a psychologist. I've then done an assessment and then all of that information is sent off to the psychiatrist. So there was this part of this expose a which was the fact that a psychologist had done an assessment, had said you've got a diagnosis. Now, even in this I'm pretty sure that is not correct practice.

11:02 A psychologist doesn't give that diagnosis. But when it came to the treatment, which is medication. The psychiatrist very quickly, within the space of ten minutes, said this is the standard sort of medication. We would normally start you on this, And it was a stimulant medication, which is the standard medication, sort of first line medication for an ADHD diagnosis. And so there was an uproar that the psychiatrist spent less than ten minutes with this person before prescribing stimulant medication. What wasn't taken into consideration was the fact that that psychiatrist was basing that on the fact that this person had been through an assessment process with a psychologist already, and that is standard practice the psychiatrist a lot of the time. I don't know currently what the process is in Australia. Maybe it's different because psychologists often un not diagnosing, but often the psychiatrist is relying on the information that has come from another trained professional. And this is the way we reduce bottlenecks in service delivery as well. The whole problem. Remember that this started with that the NHS weightlist is five years. I know that there is a long long waitlist in other countries. I know in Australia, people wait forever and spend a lot of money to get a diagnosis. There are clearly bottlenecks in the system, and so anything that we can do to facilitate an

12:35 expedite people's journey through the system to get them to where they want to be, which is a diagnosis and some medication to get back their quality of life, I would normally think that that's a good thing. Yes, we don't want to lose our best practice, we don't want to skip steps and shortcut and mismanage people. These are serious diagnosis that these are serious medications. But this, this is a professional team of clinically trained people who are relying on other people's professional training. And I think that's not a bad thing. I think I alluded to this before already. But these people who are attending private clinics.

13:26 In the UK, there are private psychiatry clinics and private specifically ADHD clinics that have popped up, presumably to respond to this increased demand for ADHD diagnosis. Now, the way this works over here, if you're not familiar, is that even as a private provider, they can apply they can be kind of listed as an NHS approved provider. So if the NHS can't provide a service to a patient within a timely manner, then a patient has a right to choose. So the patient can go to the HSGP, for example, and if the GP thinks that they again after an initial screening, if a GP thinks that they are a likely candidate that they warrants further investigation that they may have ADHD, but the wait list is five years, then the patient can request that they be referred to a private provider. In some cases, if they are actually kind of umbrellaed under the NHS, there's some sort of reciprocal arrangement thing, then the NHS can actually fund that person's assessment by the private provider. In some cases, they if it's not an official if they're not sort of a credited, approved whatever the process is by the NHS, then they need to pay out of their own pocket.

14:42 But the point being that anybody who is showing up to a private provider and paying out of their own pocket upwards of seven hundred, eight hundred one thousand pounds for a diagnosis of ADHD is not doing it for fun. There's probably a really good reason why they trying to get in to see somebody that they're willing to pay to see somebody, and that is because they're in distress. That is because this condition is making life extraordinarily hard for them. Potentially, it's been making life hard for them for many, many years, and they've only just realized that this is perhaps what's going on. And the only reason they're realizing is because suddenly everybody is talking about it.

15:31 Suddenly it is all over social media, it is all in the news, everybody's talking about it. It does feel like every other person is suddenly being diagnosed, which is what leads people to be skeptical and to question and say, oh, aren't we all a bit scattered? Oh aren't we all a bit this? Aren't we all a bit that? For somebody to go to the trouble of forking out that amount of money, This is not just because they're being a bit forgetful and losing their keys. This is not just because they sometimes walk into a room and forget why they walked in there. This has been impacting their life, their ability to function, It's been impacting their mental health. It's proven that people with ADHD often have comorbid mental health issues. They often also have anxiety They often also have substance abuse issues. They have difficulty in their working life.

16:15 They're often stressed and overwhelmed and burnt out just by trying to function in the world. It impacts their relationships, it impacts every aspect of their life. It's not being overdiagnosed. If anything, it has been underdiagnosed. It's thought that three to seven percent of children have ADHD worldwide. Significant proportion of those people will carry that condition into adulthood, and if they don't, they're probably just masking it somehow, just learning to function with it. Then it's underdiagnosed. What we're doing now, what we're seeing now is like a calibration, I guess, and we're seeing the numbers come up to probably more likely what they're supposed to be. If there is a high rate, if there is a high percentage of people going to a private clinic and getting a diagnosis, people showing up for a diagnosis and long and behold, thought you had ADHD. You got ADHD, Well, then it's probably because the people who are showing up and being willing to pay are the ones who are most likely to have ADHD. I don't know about you, but if I'm just feeling a bit forgetful and thinking, oh maybe, yeah, yeah, I forget something. I'm a bit scattered. Sometimes my house is a bit messy. A lot of the time. I don't know if I'm going to fork out one thousand pounds and go on medication unless I think that there is something seriously wrong, unless there is some serious distress going on for me. So before we all take this

17:48 one piece of pretty shody journalism, in my view, which has produced headlines all around the world, there's a lot of clickbait. There's a lot of clickbait articles. There's a lot of people talking about it. And if you just have just caught a headline, which a lot of us have, if you haven't actually watched the show, and I made sure I watched the show before I talked about it, just be mindful before you potentially allow this to kind of shift your view or have you kind of got on that path of thinking, oh, yeah, well I did think you know, you know, people are saying, oh, it's all a con it's a trend at the moment, like it's a fad at the moment. Oh everybody thinks they've got ADHD. There is so much stigma about this diagnosis.

18:37 There is so much skepticism and the people who are wondering if maybe they have got ADHD, they are already so reluctant to talk about it or to ask about it because typically the response that you get, and I've even said this myself, like sometimes I'll see ADHD criteria and I'll go, oh that, I mean all criteria. I see all of those boxes. And oftentimes people's response would be oh, well, yeah, well we all do. We all have it to some degree, like we're at a bit forgetful, we're all a bit scattered, like we're all a bit unfocused, we're a little bit disorganized, Like doesn't mean you've got ADHD. People will shut you down before they will say, well have you looked into that? Like is it possible? And maybe instead of shutting people down and dismissing people and saying.

19:23 Well you'll yeah, girl, like of course we're all forgetful, maybe it would be better to say, well, you know, what, have you thought about seeing your GP about it? Have you thought about seeing a psychologist? Because better to know and have a discussion with somebody about it. And please don't allow this, like I said, this kind of shoddy, biased report, or just if you've seen an article, or you've seen a headline, or you've seen a TikTok, or you've seen an Instagram post, or you've seen something, consider the fuller picture. I guess, you know, just let's not have that persuade us or take, you know, taint our perception and have us kind of leaning back towards this idea this is all a bit of a hoax, that it's all a bit of a con and that people are just jumping on this bandwagon and getting themselves diagnosed or that, or that professionals are just dishing out ADHD diagnoses, you know, Willy Milly without doing proper assessments. And that is not to say that some of these processes and even these providers that were in this TV show one hundred percent, they're probably there are some processes and practices that they need to look into, and I believe that they're doing that by all accounts, They've had their lawyers in and they're all reviewing their processes, the ones who were doing the wrong thing. There are people doing the wrong thing in every industry. There are people taking shortcuts in every industry. But let's not have this, you know, a couple of shoddy providers or a couple of people taking shortcuts just taint our view of the entire profession, because I think that's really unhelpful. So that's my little

20:57 rant for today. I just thought if you had seen a headline and if you're wondering what that was about, it was causing you to question or you know, reinforce this idea that it's being overdiagnosed, or that it's all a bit of a that's you know, it's all a bit of a fad, then maybe it would help to just give a broader perspective. Happy to hear your thoughts about that, Come and message me Cast Done underscore XO on Instagram. In the meantime, my Beyond Confident program if you have not heard, if I haven't banged on about it, enough is open. You can jump into that anytime. If you're on my mailing list cast done dot com forward slash subscribe. Hop onto my mailing list and any special offers will be emailed directly to you if you're thinking of joining otherwise, if you want to jump straight on in cast Done dot com Forward slash Confident, And we have had Canden Phillips the ADHD expert in to do an intimate chat with us. She was in just recently.

21:58 We've got other really great experts. It's coming in in the near future. We have these amazing people come in and do exclusive, little intimate fireside chats with our members about all sorts of topics and all designed to help you to learn to trust yourself, to believe in yourself, to overcome your self doubt, and to become your most authentic, confident version of you. That is my mission and you can find out all about it castun dot com, forward slash Confidence. If you like the show, please do make sure that you hit the subscribe button. Tell your friends. Anything that you can do to increase our listeners is appreciated. Give us a five star review on Apple or Spotify or wherever you listen to podcasts, and I can't wait to catch you on the next episode of Craby to Happy Listener.